COVID-19 AND LUNG CANCER What We Know, What We Dont Know and What - PowerPoint PPT Presentation

COVID-19 AND LUNG CANCER What We Know, What We Don’t Know and What It All Means for Current Patient Care – A Live CME Webinar Thursday, July 2, 2020 12:00 PM – 1:00 PM ET Moderator Neil Love, MD Faculty Leora Horn, MD, MSc Naiyer A Rizvi, MD Lecia V Sequist, MD, MPH

Faculty Lecia V Sequist, MD, MPH Leora Horn, MD, MSc Director, Center for Innovation in Early Ingram Associate Professor of Cancer Detection Cancer Research Massachusetts General Hospital Cancer Center Director, Thoracic Oncology The Landry Family Professor of Medicine Research Program Harvard Medical School Assistant Vice Chairman for Faculty Boston, Massachusetts Development Vanderbilt University Medical Center Nashville, Tennessee Naiyer A Rizvi, MD Price Family Professor of Medicine Director, Thoracic Oncology and Phase I Immunotherapeutics Division of Hematology/Oncology Columbia University Irving Medical Center New York, New York

Familiarizing yourself with the Zoom interface How to participate in the chat You may submit questions using the Zoom Chat option below Feel free to submit questions now before the program commences and throughout the program.

Meet The Professors PARP Inhibitors, Immunotherapy and Other Novel Agents in Gynecologic Cancers Tuesday, July 7, 2020 12:00 PM – 1:00 PM ET Faculty Robert L Coleman, MD Ursula Matulonis, MD Moderator Neil Love, MD

Key Questions and Emerging Research in the Management of HER2-Positive Breast Cancer Wednesday, July 8, 2020 5:00 PM – 6:00 PM ET Faculty Lisa A Carey, MD Ian E Krop, MD, PhD Moderator Neil Love, MD

What Urologists Need to Know About Immune Checkpoint Inhibitors and Other Novel Approaches for Urothelial Bladder Cancer Thursday, July 9, 2020 5:00 PM – 6:00 PM ET Faculty Arjun Balar, MD Ashish M Kamat, MD, MBBS Sia Daneshmand, MD Jonathan E Rosenberg, MD Moderator Neil Love, MD

COVID-19 AND LUNG CANCER What We Know, What We Don’t Know and What It All Means for Current Patient Care – A Live CME Webinar Thursday, July 2, 2020 12:00 PM – 1:00 PM ET Moderator Neil Love, MD Faculty Leora Horn, MD, MSc Naiyer A Rizvi, MD Lecia V Sequist, MD, MPH

Agenda Introduction: Personal impact of COVID-19 on patients, families, oncology professionals Module 1: Clinical care of the oncology patient without confirmed COVID-19 Module 2: Clinical care of the oncology patient with confirmed COVID-19 Module 3: Ongoing issues

Introduction: Personal impact of COVID-19 on patients, families, oncology professionals

Exploring the Current and Future Role of PARP Inhibition in the Management of Prostate Cancer Thursday, March 30, 2020 Moderator Neil Love, MD Faculty Neeraj Agarwal, MD Emmanuel S Antonarakis, MD A Oliver Sartor, MD

Faculty Neeraj Agarwal, MD A Oliver Sartor, MD Emmanuel S Antonarakis, MD

Striving for Consensus on the Optimal Management of Metastatic Non-Small Cell Lung Cancer Friday, May 8, 2020 Moderator Neil Love, MD Faculty Hossein Borghaei, DO, MS John V Heymach, MD, PhD Julie R Brahmer, MD Leora Horn, MD, MSc Edward B Garon, MD, MS Melissa L Johnson, MD Ramaswamy Govindan, MD Benjamin Levy, MD

Faculty Hossein Borghaei, DO, MS John V Heymach, MD, PhD Julie R Brahmer, MD Leora Horn, MD, MSc Edward B Garon, MD, MS Melissa L Johnson, MD Ramaswamy Govindan, MD Benjamin Levy, MD

COVID-19 AND CLL MAY 21, 2020 Understanding the Impact of COVID-19 on the Care of Patients with Chronic Lymphocytic Leukemia – A Live CME Webinar Moderator Neil Love, MD Faculty Matthew S Davids, MD, MMSc Anthony R Mato, MD, MSCE Jeff Sharman, MD

Faculty Matthew S Davids, MD, MMSc Jeff Sharman, MD Anthony R Mato, MD, MSCE

Agenda Introduction: Personal impact of COVID-19 on patients, families, oncology professionals Module 1: Clinical care of the oncology patient without confirmed COVID-19 Module 2: Clinical care of the oncology patient with confirmed COVID-19 Module 3: Ongoing issues

Module 1: Clinical care of the oncology patient without confirmed COVID-19 • Procedure in clinics (PPE, screening, visitors, medical procedures, telemedicine) • COVID-19 testing • Systemic treatments and COVID-19 — Risk of infection and complications – Chemotherapy (neutropenia), growth factors – Checkpoint inhibitors – Targeted treatment • Clinical practice patterns – Multiple guidelines/recommendations • Current approaches to chemotherapy, immunotherapy and targeted treatment – Metastatic disease – Stage III inoperable lung cancer – Adjuvant treatment

How many patients with cancer in your practice have had a suspected or confirmed COVID-19 infection? a. None b. 1 c. 2 d. 3 e. 4-10 f. More than 10

Do you currently order COVID-19 testing for asymptomatic patients who are starting on a systemic anticancer treatment? a. Yes, for all systemic regimens b. Yes, for chemotherapy only c. No

Introduction • Clinical manifestations of COVID-19 range from asymptomatic, to mild symptoms (cold, fever, cough, or other non-specific signs), to severe pneumonia leading to acute respiratory distress syndrome, which occurs in 17–29% of infected individuals • Mortality due to COVID-19 has been reported in about 3% of COVID- 19-positive patients in the Chinese population • Main CT findings include multifocal peripheral and basal ground-glass opacities, traction bronchiectasis, and air bronchogram signs. A progressive transition to consolidation, together with pleural effusion, extensive small lung nodules… Courtesy of Naiyer A Rizvi, MD

Challenges in lung cancer population • Immune checkpoint inhibitor- related pneumonitis has been reported in about 2% of cancer patients with a seemingly higher incidence in patients with lung cancer • Similarly, tyrosine kinase inhibitors can induce radiological patterns of interstitial-like pneumonitis, which develops in 4% of patients with epidermal growth factor receptor-mutant lung cancer treated with osimertinib • Chemotherapy-associated pneumonitis is known to occur in up to 16% of treated patients, and cytotoxic chemotherapy has immunosuppressive activity Calabro L et al. Lancet Respir Med 2020;8(6):542-544. Courtesy of Naiyer A Rizvi, MD

Module 1: Clinical care of the oncology patient without confirmed COVID-19 • Procedure in clinics (PPE, screening, visitors, medical procedures, telemedicine) • COVID-19 testing • Systemic treatments and COVID-19 — Risk of infection and complications – Chemotherapy (neutropenia), growth factors – Checkpoint inhibitors – Targeted treatment • Clinical practice patterns – Multiple guidelines/recommendations • Current approaches to chemotherapy, immunotherapy and targeted treatment – Metastatic disease – Stage III inoperable lung cancer – Adjuvant treatment

Reimbursement and regulatory issues aside, which adjuvant treatment, if any, would you most likely recommend for a patient with Stage IIB adenocarcinoma of the lung and an EGFR exon 19 mutation? a. None b. Chemotherapy c. Chemotherapy à osimertinib d. Osimertinib e. Other

A patient with metastatic squamous cell carcinoma of the lung and a PD-L1 TPS of 30% tests positive for COVID-19 but is asymptomatic. Which treatment, if any, would you most likely recommend? a. None — observation b. Chemotherapy c. Chemotherapy and immunotherapy d. Immunotherapy e. Other

Ca Case (Dr Horn): 68-Ye Year-Old Old Man an with ith Metas astatic tic Squam amou ous s Cell ll Lung Can ance cer 1. Delay therapy until he is negative • 68-year-old man with newly diagnosed 2. Proceed with therapy as planned stage IV lung cancer, squamous cell 3. Proceed with pembrolizumab alone histology, PD-L1 30% presents to clinic to 4. Proceed with nivolumab + ipilimumab discuss treatment options for his lung cancer. • He was previously positive for COVID-19 with RT-PCR on nasal swab. His symptoms of fatigue, anosmia have resolved. He has been asymptomatic for 6 weeks. • You retest him as part of SOC prior to starting therapy with carboplatin, nab- paclitaxel and pembrolizumab, and he is positive for COVID-19 on RT-PCR. • What do you recommend?

Ca Case (Dr Horn): 70-Ye Year-Old Old Man an with ith Metas astatic tic SCLC • 70-year-old male, smoker with stage IV 1. Test for SARS-CoV-2 and start steroids small cell lung cancer, with metastases to for presumed pneumonitis liver, lung and bone is on first-line therapy 2. Test for SARS-CoV-2 and hold steroids with carboplatin, etoposide and until you have the results atezolizumab. • He has received two cycles of therapy and imaging has shown a nice response with a reduction in his disease burden. He comes into clinic on day 8 of cycle 3 with shortness of breath, chest pain and diarrhea. • Imaging shows pneumonitis in bilateral lungs. • How do you proceed?

Factors Associated ed wi with th Sever ere e COVID VID-19 19 • Older age • Higher ECOG performance status scores, and • More advanced stage • More likely to have received chemotherapy, radiotherapy, targeted therapy, or immunotherapy but NOT surgery • Last chemotherapy treatment within 2 weeks • Less than one year since cancer diagnosis Tian et al., Lancet Oncology S1470-2045 (2020). Courtesy of Leora Horn, MD, MSc This Photo by Unknown Author is licensed under CC BY-SA